Marzano A, Smedile A, Abate M, Ottobrelli A, Brunetto M, Negro F, Farci P, Durazzo M, David E, Lagget M
Department of Gastroenterology, Molinette Hospital, Turin, Italy.
J Hepatol. 1994 Dec;21(6):961-5. doi: 10.1016/s0168-8278(05)80602-6.
We determined the prevalence of hepatitis C virus markers and the clinical course in patients transplanted for terminal type C or non-A, non-B cirrhosis. Hepatitis C virus infection recurred in 16 of 17 patients (94%) with type C cirrhosis (seropositive for hepatitis C virus prior to surgery) and in 10 of 11 patients (91%) with non-A, non-B cirrhosis whose hepatitis C virus status prior to surgery had not been determined. Markers of hepatitis C virus were detected in 4 of 16 liver transplants whose donors tested negative for hepatitis C virus prior to surgery; this figure represents the risk of hepatitis C virus acquisition from external sources at or after transplantation. In 18 of 26 reinfected patients aminotransferases increased after grafting and remained elevated throughout the 14 to 79 (mean 46.5) months of follow up. The histological findings varied from mild or moderate hepatitis in 15 patients to severe active hepatitis in two patients. Two patients developed cirrhosis; one of them died of intercurrent infection while she was receiving immunosuppressive therapy for chronic rejection. Patients transplanted for hepatitis C virus or non-A, non-B liver disease are at high risk of hepatitis C virus reinfection. However the course of recurrent hepatitis C is most often mild and compatible with a normal life and an excellent survival rate.
我们确定了因终末期丙型或非甲非乙型肝硬化接受移植患者的丙型肝炎病毒标志物患病率及临床病程。17例丙型肝硬化患者（术前丙型肝炎病毒血清学阳性）中有16例（94%）丙型肝炎病毒感染复发，11例术前丙型肝炎病毒状态未确定的非甲非乙型肝硬化患者中有10例（91%）感染复发。16例肝移植患者中有4例在术前供体丙型肝炎病毒检测呈阴性的情况下，术后检测到丙型肝炎病毒标志物；这一数字代表了移植时或移植后从外部感染丙型肝炎病毒的风险。26例再次感染的患者中有18例在移植后转氨酶升高，并在长达14至79个月（平均46.5个月）的随访期间一直居高不下。组织学检查结果从15例患者的轻度或中度肝炎到2例患者的重度活动性肝炎不等。2例患者发展为肝硬化；其中1例在接受慢性排斥反应免疫抑制治疗时死于并发感染。因丙型肝炎病毒或非甲非乙型肝病接受移植的患者丙型肝炎病毒再次感染风险很高。然而，复发性丙型肝炎的病程通常较轻，与正常生活和良好的生存率相符。
